Provider Demographics
NPI:1063938116
Name:SPROWL, KAYLA SCOTT JONES (DPT)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:SCOTT JONES
Last Name:SPROWL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 HARMONY DR
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:ME
Mailing Address - Zip Code:04346-5403
Mailing Address - Country:US
Mailing Address - Phone:207-649-1701
Mailing Address - Fax:
Practice Address - Street 1:160 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-4162
Practice Address - Country:US
Practice Address - Phone:207-622-9467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2019-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT4918225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist